Does Main Curve Flexibility Affect Screw Insertion Accuracy Using a CT-based Navigation System in Adolescent Idiopathic Scoliosis Surgery?. Issue 10 (December 2020)

• Record Type: Journal Article
• Authors: Uehara, Masashi; Takahashi, Jun; Shimizu, Masayuki; Ikegami, Shota; Kuraishi, Shugo; Oba, Hiroki; Takizawa, Takashi; Munakata, Ryo; Hatakenaka, Terue; Koseki, Michihiko; Kato, Hiroyuki
• Is Part Of: Clinical spine surgery. Volume 33:Issue 10(2020)
• Publication Date: 2020-12
• Subjects: pedicle screw fixation -- adolescent idiopathic scoliosis -- computed tomography-based navigation system -- perforation rate -- curve flexibility; Spinal cord -- Diseases -- Periodicals; Spinal cord -- Surgery -- Periodicals; 617.56059
• DOI: 10.1097/BSD.0000000000001049
• Languages: English
• ISSNs: 2380-0186

Abstract

Abstract : Study Design: A retrospective single-center and single-surgeon study. Objective: This study investigated the screw perforation rate according to main curve flexibility in pedicle screw fixation using a computed tomography (CT) guidance for adolescent idiopathic scoliosis (AIS). Summary of Background: The authors have been using a CT-based navigation system during pedicle screw insertion for AIS to avoid serious neurovascular or visceral structure injury but suspect that high main curve flexibility may account for some breaches. Data: Seventy-two consecutive patients with AIS Lenke type 1 or 2 who had undergone pedicle screw fixation using a CT-based navigation system between February 2008 and April 2018 were retrospectively reviewed. Materials and Methods: The authors evaluated the perforation rate of pedicle screws inserted into the main thoracic curve between the upper-end and lower-end vertebrae for factors associated with screw violations using multivariate logistic regression mixed models. Results: A total of 723 pedicle screws were inserted into the T4–T12 vertebrae with the aid of CT-based navigation. The respective grade 3 perforation rates according to main curve flexibility were 0%–30%: 3.2%; 30%–55%: 1.1%; 55%–75%: 5.2%; and 75%–100%: 5.5%. Main curve flexibility of ≥55% was significantly associated with grade 3 screw perforations ( P =0.02). Conclusions: Main curve flexibility of ≥55% was significantly related to screw violation in AIS surgery. Greater care is thus advised for screw insertion using CT navigation in AIS with main curve flexibility ≥55%.